An optimal treatment approach would begin in the clinic with a procedure that attends to all significant issues and continues with an at-home regimen to maintain and expand the results. In recent years, many patients have begun pursuing hand rejuvenation leading to a noticeable spike in interest in this unique procedure. 

This rise in popularity can also mean the inevitable surge of questions and doubts in the minds of practitioners regarding the hand rejuvenation treatment. Our medical team at BioScience spoke to the internationally recognized aesthetic plastic surgeon, Dr. Fabio Fantozzi. 

As a disciple of the well-known Ivo Pitanguy at Carlos University and an expert in hand rejuvenation, he shared his valuable insight on the best techniques for effective hand treatment.

What Is Hand Rejuvenation Treatment?

Hand rejuvenation is a relatively quick and straightforward procedure that can provide excellent results. This anti-aging hand lift for smoother, fresher-looking skin and less prominent veins can be achieved through two highly effective treatments - Lipofilling and Hyaluronic Acid Dermal Fillers. Dr. Fantozzi tells us that while a variety of fillers can be used, such as Poly-L-lactic and calcium hydroxylapatite, hyaluronic acid is without a doubt, the most preferred amongst them. 

“With fat grafting for lipofilling, we have to carry out an additional step, liposuction and fat decantation, which is not applicable with HA fillers, making it a less invasive and faster process, and therefore much more practical for the patient.”

Dr. Fantozzi usually aspirates 50cc of fat from flanks for hand lipofilling and uses around 10ml of HA filler per hand, depending on the case. 

“Another advantage of HA fillers is that in the case, more volume is required for effective improvement, then you can just open another box, but with fat, you have to go back to surgical aspiration making it a longer and more tedious process.” 

Dr. Fantozzi also believes in the potential of combining the two procedures. Since HA fillers are often utilized to restore the slight depressions that may occur with fat grafting, there is evidence of both the techniques being used together for an overall satisfactory result. 

“Both techniques can be combined to maximize the results for the patient.” 

However, many patients are unwilling to undergo fat aspiration due to the fear of irregularity following grafting. For them, HA fillers stand out as a better and more accessible option. It is known for its minimally invasive nature and is considered a safer option in comparison. Not to mention, in case of an adverse reaction or unsatisfactory result, doctors have a secure escape route: Hyaluronidase. 

But How Exactly Do Hyaluronic Acid Fillers Work?

Tissue integrated HA gel works by both filling the grooves between the tendons and veins and inducing fibroblast-mediated neocollagenesis. 

For this indication, Dr. Fantozzi recommends using a high-quality biphasic HA filler, such as Genefill Contour. Moreover, Genefill products have a long safety record in the market. These biphasic fillers have a fine-tuned molecular size, adequate elasticity, and last longer than others. Additionally, their non-crosslinked HA carrier also provides a smooth appearance to the hand. 

“A complete and tested product such as Genefill Contour from BioScience is always better than a mix of products. I strongly discourage combining two products or even different types of HA due to its ability to cause a possible reaction between the products, leading to serious complications, such as inflammation, infections, and allergies.

As an expert with extensive hand rejuvenation experience, Dr. Fantozzi suggests injecting the HA filler with a cannula through one entry point after applying local anesthesia. This opening should be between the wrist and the dorsal side in the superficial layer using a ‘fanning technique” with four retrograde threads between tendons. 

 “I do not suggest injecting through the fingers since it can be quite uncomfortable for the patient. In the end, it is crucial to vigorously massage the area to allow the product to distribute evenly and integrate properly.” 

 Though it may be a simple procedure, there can be a few complications when using HA fillers for hand rejuvenation, such as hematoma, inflammation, or even infection. While hematoma and inflammation resolve within a week, an infection can need a 5-day antibiotic injection therapy, such as Rocephin (Ceftriaxone) to fix the problem effectively. 

Complete knowledge of anatomy and thorough training in the technique is crucial to avoid complications during and after the treatment. Currently, not many doctors offer this treatment, but demands are bound to shoot up with the growing interest. When this happens, doctors should be ready and equipped with the knowledge to effectively and safely carry out a hand rejuvenation treatment. 

“For me, the knowledge of anatomy is always important, as well as a general and anthropometry understanding. Anthropometric parameters direct us to comprehend the symmetries of the body, which enables a harmonious result. However, when injecting with a cannula in a superficial layer and an irregular area such as the dorsum of the hand, it is not of extreme importance as it is difficult to cause major damage, unlike facial and other procedures“, added Dr. Fantozzi.

Who is it recommended for?

Since hand rejuvenation with HA fillers is a highly safe procedure, it is advised for most healthy men and women, both for correction of age-related or trauma-related alterations. Patients with comorbidities, such as herpes, psoriasis, skin diseases, allergic reactions, and also acne, warts, and mycosis are excluded.

‍Growing Demands for Hand Rejuvenation

There has been an exponential increase recently in hand treatment. In Dr. Fantozzi’s clinic in Rome, he reports 40-100 hand rejuvenations per year, and together with HA filler treatments, they represent 50% of his business. 

“I see that the demand is quickly increasing, especially by word of mouth from satisfied clients. However, it is a poorly exploited procedure, and despite its simplicity, it’s still an uncommon technique, so many physicians do not propose it to clients.” Dr. Fantozzi concluded.